Knowledge and attitude towards contraceptive methods for spacing and decision making factors regarding its use in postpartum women

Background: Though the permanent methods have been successful in our country the spacing methods lag behind and unwanted unplanned pregnancies continue to be high. This study was undertaken to explore the knowledge level, attitude and the factors influencing the potential use of spacing contraception among recently delivered women.Methods: This cross sectional study was carried out in a teaching institution using a structured questionnaire among recently delivered women willing to participate in the study.Results: Among the 404 women studied 74% were primipara. The level of awareness about spacing contraception was 70% though only 30% knew the correct use. The most frequent source of information was social circle and friends. Two thirds of women felt the need for spacing but 65.8% were not willing to adopt any modern method for fear of side effects and want of husband approval. Bivariate analysis showed that prenatal counselling (X2=41.33 P<0.001) and higher education (X2=16.6 P<0.001) were significant predictors of knowledge about spacing contraception. On bivariate analysis prenatal counselling (X2=3.83p<0.05) and prior discussion with husbands (X2=17.4 P=0.001) emerged to be the most significant predictors of positive attitude towards contraception. On multivariate analysis prior discussion with husband emerged as the most significant factor to predict the likely use of contraception for spacing (Adjusted OR-2.8; 95%CI 1.6-5.1).Conclusions: Prenatal counselling detailing about the contraceptive methods and doing away with the myths and involving husbands in these sessions would be important strategies to improve the effective use of spacing contraception among recently delivered women

Letter to Editor

Comparing Adherence in Cardiac Clinic Versus General Outpatient Clinic: Few Concerns and Way Forwar

Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal : a retrospective cohort study

Objectives: Isoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has been no systematic assessment of IPT initiation and completion rates among PLHIV. We aimed to assess IPT initiation and completion rates in the Far-Western Region (FWR) of Nepal. Design: We conducted a retrospective cohort study using secondary data extracted from registers maintained at ART centres. Setting: All 11 ART centres in the FWR of Nepal. Participants: All PLHIV registered for care between January 2016 and December 2017 in 11 ART centres. Primary outcome measures: IPT initiation and completion rates were summarised as percentages with 95% CI. Independent association between patient characteristics and non-initiation of IPT was assessed using cluster-adjusted generalised linear model (log binomial regression) and adjusted relative risk (RR) with 95% CI was calculated. Result: Of the 492 PLHIV included, 477 (97.0%) did not have active TB at registration. Among 477 without active TB, 141 (29.8%, 95% CI 25.7% to 34.1%) had been initiated on IPT and 85 (17.8%) were initiated within 3 months of registration. Of 141 initiated on IPT, 133 (94.3%, 95% CI 89.1% to 97.5%) had completed 6 months of IPT. Being more than 60 years of age (RR-1.3, 95% CI 1.1 to 1.7), migrant worker (RR-1.3, 95% CI 1.1 to 1.4) and not being initiated on ART (RR-1.4, 95% CI 1.1 to 1.8) were significantly associated with IPT initiation. Conclusions: In FWR of Nepal, three out of 10 eligible PLHIV had received IPT. Among those who have received IPT, the completion rate was good. The HIV care programme needs to explore the potential reasons for this low coverage and take context specific corrective action to fix this gap

HIV status among presumptive tuberculosis cases attending tertiary care centre in South India

Introduction: In India, to increase human immunodeficiency virus (HIV) case detection, the National Technical Working Group onTB /HIV had made it mandatory to screen for HIV infection among presumptive tuberculosis (TB) cases. Material and methods: Our study was a cross-sectional study, conducted between June 2015 and December 2016 in a tertiarycare institute (JIPMER), in South India, to estimate the prevalence of HIV among presumptive TB cases. Results: Among the 964 presumptive TB cases who attended pulmonary medicine OPD, 189 patients were sputum acid-fastbacilli (AFB) positive. Among the 189 sputum positive cases, 9 were HIV positive. Of the 964 presumptive TB cases, 879 gaveconsent for HIV testing and 33 (3.7%) turned out to be HIV positive. If only sputum positive cases had been screened for HIV,we would have missed 24 new HIV positive cases. The number needed to screen was 27 among presumptive TB cases and 18among TB patients. Conclusions: The uptake of HIV testing (91%) and the diagnostic yield of 3.7% of HIV positive cases among the presumptiveTB patients is quite high compared to that of the Revised National Tuberculosis Control Programme (RNTCP) mechanism of Puducherry.This reinforces the need to screen all the presumptive cases for HIV infection, to increase HIV case detection so thatanti-retroviral therapy (ART) can be initiated early

Are taxane based regimens better than non-taxane fluoropyrimidine based regimens in advanced gastric cancer? Findings from an observational multicentre study, South India

Background: Capecitabine, 5 Fluorouracil, platinum agents and taxanes are either used alone or in combination in advanced gastric cancers (AGC). Data on tolerability and efficacy of these regimens are minimal. We aimed to report proportion of AGC patients opting for best supportive care upfront and tolerability and efficacy of taxane and non-taxane fluoropyrimidine based regimens from three oncology centers, South India.Methods: Case records of AGC patients initiated on either taxane or non-taxane fluoropyrimidine based chemotherapy during May 2016 to Dec 2017 in three private tertiary cancer care centers across two states in south India were reviewed. Information on clinical characteristics, regimen used, radiological and clinical response, toxicity and its related hospital admissions were extracted. Statistical analysis was done by categorical variables that were summarized using proportions. Median survival was calculated using Kaplan Meier curves and comparison between the groups were done using log-rank test.Results: Of 88 AGC patients, 27 patients (30.7%) opted for best supportive care; 19 and 41 patients received paclitaxel based and non-taxane fluoropyrimidine based regimens respectively. There was no statistically significant difference in pain symptoms, vomiting, hospital admissions and intensive care admissions between the two regimens. Median (inter quartile range) survival of patients receiving best supportive care, taxane based regimen and non-taxane fluoropyrimidine regimen were 3.1 (1.5-16.1), 7.4 (1.6-15.0) and 11.6 (3.2-29.3) months respectively. Median (range) survival on any chemotherapy was 10.3 (1.6-29.3) months and it was significantly higher compared to best supportive care (p<0.001)Conclusions: AGC patients on chemotherapy had improved overall survival compared to stand alone best supportive care. Fluoropyrimidine based regimens offered better survival than taxane based regimen

Zakażenie wirusem HIV u pacjentów z podejrzeniem gruźlicy diagnozowanych w ośrodku specjalistycznym w południowych Indiach

WSTĘP: W celu zwiększenia wykrywalności zakażenia wirusem HIV w Indiach narodowa grupa robocza ds. zakażenia wirusem HIV i gruźlicy wprowadziła obowiązek badań przesiewowych w kierunku zakażenia wirusem HIV u wszystkich chorych z podejrzeniem gruźlicy. MATERIAŁ I METODY: Badanie miało charakter przesiewowy i miało na celu ocenę występowania zakażenia wirusem HIV wśród chorych z podejrzeniem gruźlicy. Przeprowadzono je w okresie od czerwca 2015 do grudnia 2016 roku w trzeciorzędowym ośrodku referencyjnym JIPMER w południowych Indiach. WYNIKI: Spośród 964 chorych z podejrzeniem gruźlicy przyjętych w poradni pulmonologicznej, u 189 chorych stwierdzono dodatni wynik plwociny w kierunku prątków kwasoodpornych (AFB). Spośród 189 chorych z dodatnim wynikiem plwociny u 9 stwierdzono zakażenie wirusem HIV. Spośród 879 chorych, którzy wyrazili zgodę na badanie w kierunku zakażenia wirusem HIV, u 33 wynik był dodatni (3,7%). Gdyby zbadano jedynie chorych z dodatnim wynikiem plwociny, nie wykryto by 24 nowych przypadków zakażenia wirusem HIV. Liczba badań, które należałoby wykonać, aby wykryć jeden przypadek zakażenia wirusem HIV (number needed to screen), wynosi 27 dla chorych z podejrzeniem gruźlicy i 18 dla chorych z potwierdzoną gruźlicą. WNIOSKI: Wykrywalność zakażenia HIV (91%) i skuteczność diagnostyczna 3,7% w grupie chorych z domniemaną gruźlicą jest wysoka w porównaniu z danymi zaktualizowanego programu narodowego kontroli gruźlicy. W związku z tym w celu zwiększenia wykrywalności zakażenia wirusem HIV konieczne jest objęcie badaniami przesiewowymi również chorych z podejrzeniem gruźlicy, aby można było wcześnie wdrożyć leczenie anty-retrowirusowe.WSTĘP: W celu zwiększenia wykrywalności zakażenia wirusem HIV w Indiach narodowa grupa robocza ds. zakażenia wirusem HIV i gruźlicy wprowadziła obowiązek badań przesiewowych w kierunku zakażenia wirusem HIV u wszystkich chorych z podejrzeniem gruźlicy. MATERIAŁ I METODY: Badanie miało charakter przesiewowy i miało na celu ocenę występowania zakażenia wirusem HIV wśród chorych z podejrzeniem gruźlicy. Przeprowadzono je w okresie od czerwca 2015 do grudnia 2016 roku w trzeciorzędowym ośrodku referencyjnym JIPMER w południowych Indiach. WYNIKI: Spośród 964 chorych z podejrzeniem gruźlicy przyjętych w poradni pulmonologicznej, u 189 chorych stwierdzono dodatni wynik plwociny w kierunku prątków kwasoodpornych (AFB). Spośród 189 chorych z dodatnim wynikiem plwociny u 9 stwierdzono zakażenie wirusem HIV. Spośród 879 chorych, którzy wyrazili zgodę na badanie w kierunku zakażenia wirusem HIV, u 33 wynik był dodatni (3,7%). Gdyby zbadano jedynie chorych z dodatnim wynikiem plwociny, nie wykryto by 24 nowych przypadków zakażenia wirusem HIV. Liczba badań, które należałoby wykonać, aby wykryć jeden przypadek zakażenia wirusem HIV (number needed to screen), wynosi 27 dla chorych z podejrzeniem gruźlicy i 18 dla chorych z potwierdzoną gruźlicą. WNIOSKI: Wykrywalność zakażenia HIV (91%) i skuteczność diagnostyczna 3,7% w grupie chorych z domniemaną gruźlicą jest wysoka w porównaniu z danymi zaktualizowanego programu narodowego kontroli gruźlicy. W związku z tym w celu zwiększenia wykrywalności zakażenia wirusem HIV konieczne jest objęcie badaniami przesiewowymi również chorych z podejrzeniem gruźlicy, aby można było wcześnie wdrożyć leczenie anty-retrowirusowe

Low Incidence of Renal Dysfunction among HIV-Infected Patients on a Tenofovir-Based First Line Antiretroviral Treatment Regimen in Myanmar.

BACKGROUND: Since 2004, Médecins Sans Frontières-Switzerland has provided treatment and care for people living with HIV in Dawei, Myanmar. Renal function is routinely monitored in patients on tenofovir (TDF)-based antiretroviral treatment (ART), and this provides an opportunity to measure incidence and risk factors for renal dysfunction. METHODS: We used routinely collected program data on all patients aged ≥15 years starting first-line TDF-based ART between January 2012 and December 2013. Creatinine clearance (CrCl) was assessed at base line and six-monthly, with renal dysfunction defined as CrCl < 50 ml/min/1.73 m2. We calculated incidence of renal dysfunction and used Cox regression analysis to identify associated risk factors. RESULTS: There were 1391 patients, of whom 1372 had normal renal function at baseline. Of these, 86 (6.3%) developed renal dysfunction during a median time of follow-up 1.14 years with an incidence rate of 5.4 per 100 person-years: 78 had CrCl between 30-50 ml/min/1.73 m2 and were maintained on TDF-based ART, but 5 were changed to another regimen: 4 because of CrCl <30 ml/min/1.73 m2. Risk factors for renal dysfunction included age ≥45 years, diagnosed diabetes, underlying renal disease, underweight and CD4 count <200 cells/mm3. There were 19 patients with baseline renal dysfunction and all continued on TDF-based ART: CrCl stayed between 30-49 ml/min/1.73 m2 in five patients while the remainder regained normal renal function. CONCLUSIONS: In a resource-poor country like Myanmar, the low incidence of renal toxicity in our patient cohort suggests that routine assessment of CrCl may not be needed and could be targeted to high risk groups if resources permit

Prevalence of Household-level Food Insecurity and Its Determinants in an Urban Resettlement Colony in North India

An adequate food intake, in terms of quantity and quality, is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world\u2019s largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. The present study was conducted with the objective of documenting the prevalence of food insecurity at the household level and the factors determining its existence in an urban slum population of northern India. This cross-sectional study was conducted in an urban resettlement colony of South Delhi, India. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting socioeconomic details and information regarding dietary practices. Food insecurity was assessed using Household Food Insecurity Access Scale (HFIAS). Logistic regression analysis was performed to determine the factors associated with food insecurity. A total of 250 women were interviewed through house-to-house survey. Majority of the households were having a nuclear family (61.6%), with mean familysize being 5.5 (SD\ub12.5) and the mean monthly household income being INR 9,784 (SD\ub1631). Nearly half (53.3%) of the mean monthly household income was spent on food. The study found that a total of 77.2% households were food-insecure, with 49.2% households being mildly food-insecure, 18.8% of the households being moderately food-insecure, and 9.2% of the households being severely food-insecure. Higher education of the women handling food (OR 0.37, 95% CI 0.15-0.92; p 640.03) and number of earning members in the household (OR 0.68, 95% CI 0.48-0.98; p 640.04) were associated with lesser chance/odds of being food-insecure. The study demonstrated a high prevalence of food insecurity in the marginalized section of the urban society. The Government of India needs to adopt urgent measures to combat this problem

Contact tracing for COVID-19 in a healthcare institution: Our experience and lessons learned

During the initial phases of the COVID-19 pandemic contact tracing was used to control spread of the disease. It played a key role in health care institute which continued to work even during lockdown. In this piece of work, we share the lessons learnt from the contact tracing activity done in the health care institution during April to July 2020. The training needs of persons involved in contact tracing, the follow of activities, use of technology, methods to fill the missing gaps were the key lessons learnt. Its documentation supports in setting up contact tracing activity for any emerging infectious disease outbreaks in future

Do pregnant women know about danger signs of pregnancy and childbirth? – A study of the level of knowledge and its associated factors from a tertiary care hospital in Southern India

Background: Awareness about danger signs during pregnancy is essential for a woman to seek prompt care. This can avert long-term morbidity and mortality. This study was aimed to find the level of knowledge and its related factors about danger signs of pregnancy and childbirth among pregnant women attending a tertiary care hospital in southern India. Patients and Methods: We conducted a cross-sectional survey of pregnant women attending a tertiary care hospital in South India. Systematic random sampling of every 10th woman exiting the antenatal clinic was done. Results: We studied 382 pregnant women. Of them, 188 (49.2% [95% confidence interval (CI): 44%–54%]), 104 (27.2% [95% CI: 23%–32%]), and 81 (21.2% [95% CI: 17%–26%]) women had sufficient knowledge about danger signs during pregnancy, labor, and childbirth, respectively. On multivariable analysis, lack of exposure to formal awareness raising health counseling classes was the only factor found to be significantly associated with a lack of knowledge about danger signs of pregnancy (adjusted prevalence ratio, 95% CI: 1.8 [1.2–2.7]) and after childbirth (1.4 [1.1–1.7]). Lower education level was significantly associated with a lack of knowledge about danger signs of labor (1.2 [1.1–1.4]). Conclusion: We found that lack of exposure to formal awareness raising health counseling classes is a modifiable risk factor to improve knowledge about danger signs. We recommend structured mandatory health awareness sessions addressing the danger signs of pregnancy and child health to all pregnant women